Abstract
Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein. Upper Extremity DVT (UEDVT) accounts for 5% - 10% of all cases of DVTs. Previously it was thought to be a rare disorder. However in recent years with the advent of various indwelling intravenous devices, hypercoagulable state like COVID-19, secondary UEDVT did not remain infrequent presentation anymore. Though primary UEDVT, also known as Effort Thrombosis, that takes place without any underlying obvious pathology is a rare form till now. We presented a case of 46 years female who presented to the emergency with complaints of progressively increasing pain (7 days) and swelling (3 days) of her right forearm since last 7 days following strenuous and heavy work by her dominant/ right hand during the period of festival. She initially ignored her condition because of the Durga Puja festival. As her symptoms deteriorated she eventually had to attend the emergency department. Eventually an urgent ultrasonography color Doppler was done on emergency basis which diagnosed underlying DVT of her right brachial vein. She was managed with low molecular weight heparin, urgent fasciotomy owning to her impending compartment syndrome. Other tests ruled out any secondary underlying pathology. She improved and discharged without any complications on oral anticoagulant. Exigent events in her history were trauma followed by fall on her right elbow 2 months back and then presenting signs & symptoms commencing at the same region following strenuous, tedious activities over 7 days and consequential effort thrombosis of her right brachial vein. All of that compelled us to ruminate on rare differentials of her presentation and eventually come to this rare diagnosis. The author hence brought this pedagogic case to the readers, especially emergency & primary care physicians and emphasised the importance of being intuitive about rare but deadly differentials which come from proficiency & experience in the field of medicine.
Highlights
Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein [1]
Other tests ruled out any secondary underlying pathology. She improved and discharged without any complications on oral anticoagulant. Exigent events in her history were trauma followed by fall on her right elbow 2 months back and presenting signs & symptoms commencing at the same region following strenuous, tedious activities over 7 days and consequential effort thrombosis of her right brachial vein
The author brought this pedagogic case to the readers, especially emergency & primary care physicians and emphasised the importance of being intuitive about rare but deadly differentials which come from proficiency & experience in the field of medicine
Summary
Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein [1]. PE, the most dreaded complication of any DVT, rates up to one third of the patients with UEDVT [2]. Primary UEDVT is a rare disorder (2 per 100,000 persons per year) [3] that refers to effort thrombosis, called Paget-Schroetter Syndrome or idiopathic UEDVT. Patients with Paget-Schroetter Syndrome develop spontaneous UEDVT, usually in their dominant hand following repeated strenuous activity, like heavy weight lifting, wrestling, rowing etc. Patients with idiopathic UEDVT usually do not have any known trigger or obvious underlying disease. In cases of proximal UEDVT where compression US is not possible because of incompressibility attributed to anatomical location of the veins, subclavian & brachiocephalic, Color Doppler US is used instead. DOACs were employed in maintenance therapy of DVT on account of 40% reduced chance of major hemorrhage in comparison to VKA. Maintenance therapy usually commenced for 3 - 6 months and can be prolonged depending upon underlying clinical condition [16]
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